Let's Geek Out!!

Neurology is rolling right along. Yesterday I was basically one-on-one with my attending because my partner took two (yes TWO hours) to see and write a report on a patient who is for all intents and purposes braindead. I have many questions...but moving along. The first patient had an array of symptoms that were fascinating to observe as a student. He had a present Babinski sign on the L, a L ankle clonus, and diminished L knee reflex. I became unnecessarily excited when I observed the Babinski: "Um, doctor, I think this is an upgoing Babinski. Do you want to verify?" I was indeed! Same with the clonus. I didn't see it, but felt the ankle jerk an extra time after the initial reflex, which I initially didn't think anything of, but after a second I asked the doctor to verify that as well, and indeed, I was paying close attention! Go me??

Later, we had a patient who has a history of thrombotic thrombocytopenic pupura. She had significant neurological damage. She had a rubral tremor, and noticeable cognitive impairment. Getting her to do Serial 3's (1, 4, 7, 10, 13...etc), you'd think I was asking her to do quantum mechanics. So all in all the doctor said I did very well with those cases.

Fast forward to today. We had a patient come in who on top of being hard of hearing didn't speak English as her first language (not unusual). We knew ahead of time that she had a pontine lesion, so the attending asked us to pay special attention to her cranial nerves. I noticed what I found out to be square wave jerks in her eyes. The doctor did not notice that immediately while my partner was doing the exam, and appreciated me calling it to his attention. Also this morning we had a patient who was known to the doctor. He had me examine her cold and to find her abnormality. I correctly diagnosed her problem as an ulnar nerve neuropathy. She had a noticeable left palpebrae that wasn't equal to the right, and I noticed she also had a slight left-sided mouth droop while the doctor was addressing a sensory complaint in her arm. I was able to bring that to his attention. I felt unnecessarily accomplished, and totally geeked out. 

I'll leave with some awesomely bad jokes from my attending:

Did you hear about the Invisible man ? He married an invisible woman. Their kids aren't much to look at.

Disgruntled patient who just happens to be an NRA member: "If another doctor tells me there's nothing wrong with me I'll kill him."

Doc: "There's definitely something wrong with you." 

A big giant WHY...

This morning my attending asked my partner and I to evaluate a seizure patient...but wait!!! The patient is sedated. Hope the attending doesn't mind ten pages of "unable to assess."


Follow up!!: As I was reading through the previous notes (the patient has been in the hospital for quite a while) I came across a real gem. According to a wonderfully written progress note: "Pt had this morning that lasted for 30 min..." Pray tell what did he have? Seizures? Vomiting? Headache? Fits of rage? Priapism? I'm all ears doc...

Traveling

I'm flying back to Atlanta this weekend for a family function. For those unaware, parts of the Blue Line leading to O'Hare run in between the Kennedy Expressway, and this includes the platforms. I was standing on the platform waiting for my train and watched the cars fly by in both directions. This is a rarity on the Kennedy as it can logjam at any time of day simply because somebody in Idaho sneezed.  It was rather exhilarating to see and hear the cars zooming by in both directions. People moving into the city, going out of the city. All at 80mph. Either it really was that cool, or I was just awake and at it way too flippin' early this morning.  

Today's Observations

1. It's 85 degrees, unless you're from Saudi Arabia and find that cold, why are you wearing a scarf??

2. Anyone attempting a left turn at Addison and Clark on Cubs game day needs their head examined. And deserves to be tazed for backing up traffic even more...because you know they're never going to get to actually make that turn.

3. I like neurology. My attending says I'm doing well and has allowed me to do exams on my own. However, I was thinking about going into neurology before this rotation. I find it interesting, but I am no longer considering neurology.

The TVs at the gym just happen to be playing Maury...apparently his people have found and exhausted the available supply of no-good baby daddy's, because today's topic was "I'll prove my *dead* son isn't your baby daddy"...

Neurology

This week I started my neurology rotation. It's been interesting, but also a lot of work. I don't really mind it. I'm not crazy about the hours, however. They aren't long, but they are late, so they might as well be long. I haven't been getting home until after eight most evenings. I'm accustomed to getting up and out early, and doing my errands in the evening. This means I have to reverse that pattern for a few weeks, which is kind of weird.

The doctor is nice, but sometimes the way he talks makes him come across as a bit of a jerk. For example, yesterday he was quizzing us about random neurological signs, and I hadn't the foggiest clue what the sign was. I asked him if he could spell "Lhermitte's" sign, and he just replied "No."...Thanks dude. I've never heard of that, or if I have it has long been forgotten.

I'll be the first to admit neuroanatomy was not my favorite or best subject. I think you have to be a witchdoctor to understand a lot of the pathways and crossings.

Yesterday we had neurology clinic, and we have several new patients. The first patient of the day, the doctor said "Okay luckyone, you're going to do the exam. Unless you would prefer me to do it, this might be a difficult case." Well, of course I'm not going to back down from that. Sink or swim I told him I would be fine to do the exam, even though I was indeed nervous. I started taking my history, and not too long after I started he suggested that I not ask quite so specific questions, which threw my rhythm off a bit as I was trying to ensure that I didn't get reprimanded for asking "too specific questions." Nerves, but oh well. I'll get there. So, I was trying to concentrate on asking broader questions, and it needed a bit of work. Some of the things he noted that I didn't ask or facts that I didn't obtain I recall indeed obtaining. Perhaps not the proper way or to his liking, but I did get that information.

My exam was fine, I think. A bit unorganized, but I have never done a complete neuro exam before and I didn't want to do it by the list because the order looked a bit weird to me. Maybe I'm slightly dyslexic, but I stay on track easier if I do things in groups. I only had to be corrected on one task, and that was just a brainfart.

QOTD

"I had a patient once who tried to commit suicide by shooting herself in the neck. She missed everything. When I asked her about the pain, she described it as a shooting pain. I had to excuse myself from the room to avoid laughing."

Moral of the story: when you attempt suicide either make it count, or at least work on your descriptors.

Good to Know...

Patient: "Please leave the room and close the door. Lucifer is trying to have sex with me." Patient is actively simulating the act and mentioning how delicious Lucifer's penis apparently is.

Sure, no problem. Mad dash for the Haldol.